Shaylie Elliette wishes the Trans Health Equity Act that appears headed for final passage in the Maryland General Assembly would have been around seven years ago, when she turned 18. She believes that transitioning earlier in life would have eliminated years of torment, abuse and discrimination all linked to transphobia.
“I desperately want to get surgeries done to make my body and face match my gender identify,” the 25-year-old Charles Village resident said. “The ability to pass [as a woman] affords you the freedom of invisibility from those who would wish to harm you.”
The Trans Health Equity Act would require Maryland Medicaid to cover gender-affirming care and procedures for transgender patients. The measure, versions of which have been passed by both chambers of the Maryland General Assembly, is still awaiting final passage. It would then go to Democratic Gov. Wes Moore, who is expected to sign it into law. It would take effect Jan. 1, 2024.
Some gender-affirming care, a term often used to describe medical care for someone who is transgender, is currently covered by Maryland Medicaid. The dozen uncovered procedures range from invasive surgeries and voice therapy to laser hair removal.
The bill does not change the state’s existing Medicaid policy of not operating on transgender youth. Transgender people under age 18 are currently prescribed reversible puberty blockers and hormone treatment. In addition, parental consent is required in Maryland for all health care decisions for transgender youth.
In 2022, nearly 100 people sought gender-affirming care under Medicaid, the state-federal health insurance program for some low-income people and people with disabilities. That number is expected to jump by an additional 25 people per year if the measure becomes law, according to a legislative analysis. The addition will increase the state’s Medicaid budget by 0.005%.
Under the measure, about 10,000 transgender people would have access to gender-affirming care in Baltimore, according to Phillip Westry, the executive director for FreeState Justice, a Baltimore-based legal advocacy organization that assists low-income LGBTQ Marylanders.
Elliette does not know if she qualifies. But she is interested in pursuing it.
“I would probably have transitioned when I was 18. And I would have taken hormone replacement therapy before I experienced ‘male puberty,’” she explained.
Instead, Elliette has had to transition at a slower pace.
“I’ve only been able to afford laser hair removal because I got a loan to cover the cost,” the artist and server said. “I have no idea how I will ever be able to afford any other transition-related surgeries in the future because of the cost barrier.”
Elliette said, for example, that surgery to create a vagina from a penis costs $70,000. That does not include the aftercare or the cost of staying in a facility for recovery. It would cost a total of $100,000 to help Elliette better present as a woman.
She hopes the bill will open doors for transgender Marylanders.
“It means freedom from something that we had no choice in the matter of,” she said. “It means safety, and a lot of the time it means an incredible reduction in anxiety and fear for one’s life and future.”
Advocates call passage of the bill by both chambers a victory that could save the lives of transgender community members.
Londyn Smith de Richelieu, director of the Mayor’s Office of LGBTQ Affairs in Baltimore, said improving health care access and “bettering the lives of our most vulnerable” are top priorities.
“I have lost an overwhelming number of friends whose lives were cut short due to lack of access to quality health care,” she said. “It was a serendipitous moment to deliver testimony on the Trans Health Equity Bill on Valentine’s Day, a love letter to the resilience of the trans and nonbinary community, and then to have Maryland stand on the right side of history the week of LGBTQ Health Awareness. We stand on the shoulders of many to reaching this crowning achievement.”
Victoria Kirby York — director of public policy at the National Black Justice Coalition, a Black LGBTQ+ civil rights organization — said she hopes the bill will provide protection and peace of mind for Black transgender women.
“This is a big win — especially for Black transgender folks in the state of Maryland, who are often underpaid, underemployed and deserve to have the health care that private insured people are enjoying,” said Kirby York, who lives in Maryland. “Gender-affirming care really does save lives. People who are able to live authentically to their spirit is a game changer.”
Westry said that he is pleased that a version of the measure has been passed by both chambers, but there are still many steps to go to achieve equality for the trans community.
“Health care is a big step,” he said. “But we are going to be focused on other discrimination issues around housing and employment. Education, health, and housing — those are the next steps for us.”
The passage of the bill shows the power of the LGBTQ community, according to Westry.
“LGBTQ representation is starting to show its strength and what can be done to support the community overall,” he said.
Not every state is embracing such policies. Conservative lawmakers in the South and Midwest have taken aim at LGBTQ people, with Texas’ Republican governor ordering state officials to open child abuse investigations into reports of transgender kids receiving gender-affirming medical care. Some Republican leaders in these states don’t want teachers discussing same-sex marriage in public schools or transgender children playing in, for example, youth athletic leagues.
Sam McClure, executive director of the Center for LGBTQ Health Equity at Chase Brexton Health Care, said the health care provider is “grateful” to the Maryland legislators who back the trans health bill.
“We are a community health center and it is our mission to provide compassionate and integrated high-quality health care that honors diversity, addresses health inequities, and advances wellness in the communities we serve,” McClure said. She said the measure “addresses health inequities for transgender people in our state.”
Heather Morris, a member of Howard County’s PFLAG chapter, said in submitted testimony that while her children have private health insurance and receive all necessary gender-affirming care, there are transgender Marylanders who “do not have that essential provision.”
Morris added: “Transgender individuals who do not receive appropriate healthcare are at greater risk of depression, suicide, exploitation and more. But with care, they can go on to lead a healthy, productive life as an active Maryland citizen.”
Morris said she has witnessed “a multitude of ways” that transgender youth and adults suffer “when they are not allowed to live their truth.”
“Transgender individuals deserve healthcare that allows them to prosper and thrive, just as all Marylanders do.” Morris said. “The benefit of supporting our transgender community far outweighs the small cost it will incur to enact this bill.”